Uveitis Flashcards
what is uveitis?
inflammation of uveal tract
what are the 4 types of uveitis
- anterior
- intermediate
- posterior
- panuveitis
what are the 2 types of anterior uveitis?
- iritis
- iridocyclitis
what part of the eye does iritis affect?
iris
what part of the eye does iridocyclitis affect?
iris and anterior ciliary body (pars plicata)
aetiology?
- autoimmune
- prior infections (Herpes simplex and zoster etc)
- idiopathic
- trauma/infection
what can anterior uveitis be classified as (2 groups)?
Granulomatous
Non- granulomatous
what is non-granulomatous uveitis?
- acute onset
- fine KPs
- idiopathic
what is granulomatous uveitis?
- chronic
- mutton fat KP’s and iris nodules
- linked to systemic conditions
which antigen will you most likely test positive with if you have anterior uveitis?
HLA-B27
typical symptoms of anterior uveitis?
- Red eye
- Unilateral (bilateral or alternating if chronic)
- rapid onset (acute)
- moderate-severe dull pain (behind the eye)
- reduced/hazy vision
- photophobic (less when chronic)
- epiphora
SIGNS of anterior uveitis
- ciliary flush
- KPs
- cells and flare
- iris nodules (granulomatous)
- miosis
- raised IOPS
the larger the KPs…
the more chronic the condition
what is kruckenberg’s spindle?
melanin forms a line on central cornea
what are cells?
WBCs
how do you grade cells?
SUN grading scale:
what is flare?
proteins leaked from damaged iris blood vessels - bv = increased vascularity
cells + flare =
active inflammation
flare with NO cells =
no active inflammation
2 types of iris nodules?
- bussaca
- koeppe
what are bussaca?
whitish yellow lumps on surface of iris
- internal iris stroma
- GRANULOMATOUS UVEITIS
what are koeppe?
cellular aggregates at the pupil border
accumulate pigment over time
what are the complications of anterior uveitis?
anterior and posterior synechiae?
where are anterior synechiae?
between iris and posterior cornea
where are posterior synechiae?
between iris and lens
OPTOM MANAGEMENT OF FIRST EPISODE?
urgent (1 week) referral to ophthalmologist
if severe pain, reduced VA or raised IOP - SAME DAY
- sunglasses for photophobia
- cycloplegic to prevent synechiae formation and reduce ciliary spasm
- analgesics
OPTOM MANAGEMENT OF SUBSEQUENT EPISODES?
- refer back to HES
- check IOPs
- monitor for ocular complications
- near add for cyclo?
Opthalmologist management of anterior uveitis?
- cyclopentalate 1%
- steroid (dex or prednisolone)
- treat any glaucoma or immunosuppression
DDs of anterior uveitis?
- scleritis
- episcleiris
- angle closure glaucoma
what is the least common type of uveitis?
intermediate
what conditions have a strong link with intermediate uveitis?
Multiple Sclerosis (MS)
which parts of the eye are affected in intermediate uveitis?
pars plana
extreme periphery of retina
choroid
symptoms of intermediate uveitis?
- bilateral
- floaters - inflam cells / debris in the vit humour
- reduced VA - inflam cells in the vit humour
- hazy vision
signs of intermediate uveitis?
- yellow exudates in peripheral retina
- exudates may break off and form snow banks
OPTOM MANAGEMENT OF INTERMEDIATE UVEITIS
- refer to HES “soon” (dunno about timescale sorry)
Opthalmological management of intermediate uveitis?
- steroid drops
- steroid injections
- immunosuppressants
- vitrectomy
what are the complications of intermediate uveitis?
- secondary glaucoma
- PSC
- vitreous detachment / haem
- RD / tears
- ONH swelling
- macular oedema
what is the most common cause of posterior uveitis?
toxoplasmosis
signs of posterior uveitis?
retinitis (right) and choroiditis (left) and vasculitis (bottom)
OPTOM MANAGEMENT OF POSTERIOR UVEITIS
referral to HES “soon”
what parts of the eye does panuveitis affect?
UVEA = iris + ciliary body + choroid
retina
vitreous humour
what’s the difference between hypopyon and hyphema?
hypopyon = WBCs in AC
hyphema = RBCs in AC
